Presentation on theme: "What best describes the doctor in You?"— Presentation transcript:
1 What best describes the doctor in You? How would you like to be known 5 years from now ?What do you need to do to get there ?
2 Customer Satisfact- ion Where Am I ?Customer ServiceCustomer Satisfact- ionCustomer Delight
3 The truth about Customers… People talk aboutBad ServiceOn an average, for each customer who complains there are 26 who feel the same way and don’t speak up.Customers relate to people…not organizationsThe customers who feel poorly served will tell between 8 and 16 people about their negative experience.Customers are lost primarily due to indifference and not dissatisfactionPeople don’t talk about Adequate ServicePeople talk about Customer Delight
4 Actually… What should we be doing? To stand out in the crowd Customer expectations are typically not very highYour job is to Surprise themCustomer Delight is doing what they haven’t even imaginedWhat will cause them to say WOW!You know what you can do , they don’t !!!What should we be doing?To stand out in the crowdTo create a life changing experienceTo create stories about usTo create Patient Delight !!!
5 Patient Empathy- The Differentiator You do not merely wantto be considered the best of the best…. You want to be consideredthe only one who does what you do !!!
6 How our patients see us… The Doctor is held in high regard by patientsA heroic figure, who is my ally in fighting against my diabetes,My Dr continues to deliver despite being under significant time pressuresThe Doctor is the primary information sourceMost authoritative, most credible, best person to consultBUTDoctors are time poor and can only provide limited consultation timeBUTDoctors do not treat me as an individualBUTDoctors can be judgemental6
7 What do they feel…Only one in four see their physicians once a month or more often while majority ofthree in four see their physicians about once in two months or lessfrequently.One in five respondents see their physicians for less than ten minutes at eachconsultation on average, some as short as two or three minutes.Only one in ten respondents get to see their physicians for at least 20 minutes onaverage.COUNTRYTYPE OF HCP CONSULTEDVISITS DOCTOR ONCE A MONTH OR MOREVISITS DOCTOR LESS THAN ONCE A MONTHAVERAGE CONSULTATION TIMEIndiaGP – 5 in 6 Specialist – 1 in 61 in 43 in 4<10mins: 1 in 5 >20mins: 1 in 10“I trust my doctor, I depend on him, he is professional, he takes responsibility for my health, however, he does not always have time to discuss with me.”7
8 Treat the ‘Person’ with the ‘Disease’ EducationCounselingMeaning of a diagnosisAccepting the diagnosisHow can it be managedHow you can manage itWhy take treatmentHow treatment can make you feel betterDo’s and don’ts for the familyEnabling open communication between patient & family“This is what you need to do”“You can do it!”Education gives knowledge and awareness so that the expected behavioral change is well-understood.Counseling is preparing the mind to be open to receive a new belief.
9 Voices of Patients- Exercise “I don’t want others to know I have diabetes”“Diabetes can be a very lonely world for me”“Treat me like an individual, not a patient”“I can never switch off”“I want to be in control of my diabetes, notthe other way round”
10 Voices of the patients: I don’t want others to know I have diabetes There is a perceived stigma about diabetes due to the association with diet, in particular sugar, and sedentary lifestyle.many people believe that diabetes is in some ways a self inflicted condition and patients only have themselves to blame. The general public has a poor understanding of diabetesIf people know that you are a diabetic patient you are likely to have an awkward, frustrating conversation. Patients are quizzed on what they can and cannot eat/ drink, how diabetes affects their lives and how it is treated. This lack of understanding can also manifest itself in negative ways. Some patients prefer not to make it known they are diabetic in case it harms their career.Diabetics do not want to be thought of as being different or special.If its known you are a diabetic people stop thinking of you as just another person and start seeing you as an invalid.Diabetic patients think of themselves as a person who happens to suffer from diabetes not simply as a diabetic.Is the above Good to Know or Need to Know ?10
11 Treat me like an individual, not a patient Voices of the patients: Diabetes can be a very lonely world for meDiabetes sufferers do not want to be a burden on their family members, nor do they want to worry them. As such, they tend to bottle up their emotions leading to a sense of isolation.The doctor is too busy, friends and family don’t understand them, they don’t want to be a burden to those close to them.However there was also a reluctance to attend meetings and seminars because patients do not want to be in a roomful of sick people, listening to other people complain.Therefore although they are lonely there is a reluctance to reach out and connect with othersTreat me like an individual, not a patientPatients feel that they are losing part of their identity.Doctors have such limited time they tend to treat the individual as just one more insulin patient.Education materials are too generalized to be of much use.Some of the respondent have been living with diabetes for more than 10 years therefore they do not want to go to a seminar for recently diagnosed patientsThere is a sense of frustration amongst the patients interviewed that doctors and the healthcare industry treats them as just another diabetic. There is a desire to be treated as an individual11
13 Voices of the patients: I can never switch off Insulinised diabetes patients can never forget they have this condition.Eating the wrong thing, forgetting an injection, switching off for a moment can have enormous consequences.They are constantly asked by family members whether they have had their shot or what their blood glucose levels areThe constant need to be vigilant acts as a constant strain for the patient.This constant strain can lead to mood swings, anxiety, depression and patients can be short tempered with their family membersTherefore living with diabetes is not just about injecting and watching your diet there is also the psychological pressure.Voices of the patients: I want to be in control of my Diabetes, not my disease in control of mePatients would like to know what exactly they can doThey want to learn from others who have had similar experiences.They want to hear that, with careful management, it is possible to lead a full and rewarding life in spite of diabetesIs the above Good to Know or Need to Know ?13
14 Patient Satisfact- ion Where do I want to be ?Patient Satisfact- ionPatient ServicePatient Delight
15 Steps in Counseling Rapport-building Identifying counseling goals Assessment of patient’s level of copingPatient typingPractical considerationsCounseling intervention
16 1. Rapport building* WHY HOW TO DO IT Important – but often overlooked History TakingWHYHOW TO DO ITImportant – but often overlookedAims to build a trust relationship patient feels free to confide in youListen and respond – do not do all the talkingAsk the patient about themselves (open ended questions):Where do you come from?What work do you do?Tell me about your familyChoose a quiet placeBody language, smile, eye contact are important1. How are you? How is your health?3. Is treatment helping you? Are you facing any problem?5. How can I help you ?
17 2. Identifying Counseling Goals Presenting problemHelp patients and families accept the diagnosisHelp equip them with information on disease managementHelp develop a positive and pro-active approachHelp initiate and maintain life-style modificationsHelp compliance to desired treatmentCope with morbidity of complicationsSocio-economic support to enable treatment
18 3. Assessment of patient’s level of coping Staging of diseaseDifferent patients cope differently when faced with diabetes.Hence, assessment of the coping level of the patient isImportant to decide on the counseling approach.A patient’s level of coping may vary at different points of thedisease and treatment.StageAgeSexSESPreviousKnowledgeFamily/PeerSupport
19 Coping Map… + ve effect on coping - ve effect on coping Stage Previous KnowledgeAgeSexSESFamily/Peer support
20 Stage…and its possible impact Assessment of Level of Coping (Table 2b)Counselling FocusAs disease progresses patient begins to lose hope“What were you told earlier about the disease?”Early stage:Build hope in the patientHelp him develop positive approach to treatment.Progressive stage:Filter informationKeep care giver informedBuild positive picture to the patientSexAgeStage…and its possible impactAssessment of Level of CopingCounseling Focus1StageAs disease progresses patient begins to lose hope“What were you told earlier about the disease?”Early stage:Build hope in the patientHelp him develop positive approach to treatment.Progressive stage:Filter informationKeep care giver informedBuild positive picture to the patient [i1]And instead of / [i2]Look for myths/misconceptions [i3]The guilt also arises because they are not able to take care of their family due to the illness. [i4]who does not have family/peer support
21 Previous Knowledge…and its possible impact Assessment of Level of Coping (Table 2b)Counselling FocusAs disease progresses patient begins to lose hope“What were you told earlier about the disease?”Early stage:Build hope in the patientHelp him develop positive approach to treatment.Progressive stage:Filter informationKeep care giver informedBuild positive picture to the patientAgeSexPrevious Knowledge…and its possible impactAssessment of Level of CopingCounseling Focus2Previous knowledge of diseaseA. The amount and quality of the informationB. Previous experience with the diseaseEvaluate what the patient knows about DiabetesAny myths / misconceptions?Fill in the gaps in knowledge in a non-threatening way [i1]And instead of / [i2]Look for myths/misconceptions [i3]The guilt also arises because they are not able to take care of their family due to the illness. [i4]who does not have family/peer support
22 Age…and its possible impact Assessment of Level of Coping (Table 2b)Counselling FocusAs disease progresses patient begins to lose hope“What were you told earlier about the disease?”Early stage:Build hope in the patientHelp him develop positive approach to treatment.Progressive stage:Filter informationKeep care giver informedBuild positive picture to the patientSexAgeAge…and its possible impactAssessment of Level of CopingCounseling Focus3AgeRelated to family support and economic statusMay have +/- ve effect on copingMiddle aged person + good family support + means to take Rx copes wellBreadwinner – disease may affect income generation may cope badlyElderly – often fatalistic usually accept the disease easily except in the absence of family &/or financial supportMap the patient: age, stage of disease, previous knowledge, socioeconomic status & family supportThis helps to recognize where the patient needs help
23 Sex…and its possible impact Assessment of Level of Coping Men and women could be affected differently.Assessment of Level of CopingCounseling Focus4SexMen: Disease seems to take away a sense of control dependency anger, irritability some may mask fear by denialWomen: Often feel guilty because of extra financial burden on the family.Men: How to bring back the controlWomen: Value of self-careBoth: Good self management will ultimately benefit themselves and their families
24 SES…and its possible impact Assessment of Level of Coping Counseling Focus5Socio-economic statusHas direct effect on coping because of thecost of Rx and loss of income due to the diseaseIn India, This burden is felt across socio-economic strataAssess the pt’s needEnsure provision of affordable Rx optionsAdvise means of seeking financial assistance where necessaryEmphasize that timely & regular Rx will save long term costs
25 Fly/Peer Support…and its possible impact Assessment of Level of Coping Counseling Focus6Family / peer supportPatient with good support system will cope much better than the patient who is considered a burden by his familyFor patients with little /no family support, Counselor needs to support the patient while gradually helping him to become independent, self-reliant and confident.
26 Coping Map…To assess the overall coping level by seeing how each of these positively or negatively affects coping.Mrs. S knows she has an early stage disease which can be controlled. However, she is very fearful of treatment which she has heard is very painful. She is young, has a good socio-economic support so can afford the treatment, and has a very caring husband.
27 Coping Map… + ve effect on coping - ve effect on coping StagePreviousKnowledgeAgeSexSESFamily/Peer supportTherefore, the counseling will focus onClearing her myths about treatment,Importance of timely treatment since it is an early stage disease andEmphasizing on her age and favorable prognosisFamily support & responsibility towards them
28 4. Patient typing * The Pro-Active patient The Skeptical patient The Overconfident patientThe Resigned patientThe Casual patient
29 Attitude to Controlling Diabetes The Pro-Active patientCharacteristicsAttitude to DiabetesAttitude to Controlling DiabetesKnows severity of the diseaseIndependent & curious by natureMotivated for self-careWell informed“I will keep my Diabetes under control”“I have a serious problem, but it is not the end of the world – I just have to make adjustments”“This will actually help me discipline my life”Fully involvedOptimisticRegular for follow-upFollows dietary restrictionsTakes drugs regularly and on timeExercises regularly
30 Attitude to Controlling Diabetes The Skeptical patientCharacteristicsAttitude to DiabetesAttitude to Controlling DiabetesWants good results with low inputsLow awarenessLives for today – short term benefits more important than long term benefitsLooks for low-effort, convenient options“This can wait – I have other things to do” – postpones treatment“I do not want to take Insulin” – looks for alternate drugs / home remedies even though insulin is essential.“Doctor, can you tell me when I can stop treatment?”Average involvementIrregular for follow-upLenient in following dietary restrictionsComfortable with OHA; avoids InsulinExercises sporadically; tends to give excuses
31 Attitude to Controlling Diabetes The Over-confident patientCharacteristicsAttitude to DiabetesAttitude to Controlling DiabetesLow awareness – claims that he knows it allSelf-medicationRelies on friends & relatives for advice rather than on his doctorStubbornLifestyle changes inconsistent“This is not serious – I can manage”“This drug has not worked – let me try that other drug” – tends to experiment“I won’t see the doctor this month – I am doing okay!”Needs flexibility in routine – prefers not to be bound by fixed dietary regimenDoes not feel the need for follow-up with the doctor after initial diagnosis and prescriptionLikes to choose his medications
32 Attitude to Controlling Diabetes The Resigned patientCharacteristicsAttitude to DiabetesAttitude to Controlling DiabetesFear drives him to treatment – “Diabetes will kill me silently”Curses fate “Why me?”Poorly aware – does not seek to know betterLacks self confidenceDepends on othersGoes by the rules“This disease will affect my whole life and will finally kill me”“There is no cure – I just have to obey the Doctor’s orders”“I cannot enjoy my life anymore”“I must somehow save myself from coma, heart attack and blindness”Mechanically follows instructions“Doctor’s exercise routine”“Doctor’s medication”“Doctor visits”“Doctor’s diet orders”
33 Attitude to Controlling Diabetes The Casual patientCharacteristicsAttitude to DiabetesAttitude to Controlling DiabetesNot bothered about self care, health or diabetesNo drive to know more“Fate brought this disease – let fate take care of me”Everything else is more important than self or diabetesDefeatist attitude“This disease is nothing serious – it can be controlled easily!”“I know I need to exercise control” – but unwilling to practise it“I don’t need a regimen to tackle my problem”“I am feeling tired today – I must remember to take my drugs”“Treatment of Diabetes is too costly for me – it is not worth the expense”Does not practise control regularlyEscapist attitude – gives lame excusesHealth is last priorityTreatment of Diabetes is for getting rid of symptoms and to keep his family happy – not for self
34 5. Practical considerations Time per patientDuration of associationInformation-sharing: how much is too much ?
37 Models of Behavior Change Health Belief ModelThis model states that people calculate ‘return on investment’ basedon own perceptions.Factors considered important in healthcaredecisions [Richards 1997]Perceived severityPerceived susceptibilityValue of the treatmentCost of treatment – physical and emotional
38 Correlation of Health Beliefs with Patient Types Perceived SeverityPerceived SusceptibilityValue of treatment / life-style modificationsCost (Tangible / Intangible)Pro-active patientHighLowSkeptical patientLow (Seeks immediate answers)High (unless results are immediate)Overconfident patientUnsure (pretends otherwise)Resigned patientHigh (Anxiousness negatively affects approach to Rx)Low (Will do anything to take diabetes away)Casual patientUnsure
39 Models of Behavior change Empowerment ModelThis model states that that our job is not to make people change, butto provide information, inspiration and support that will enable them tomake the changes of their own choosing.Identify the problemExplore feelingsSet goalsMake a planEvaluate the results
40 Key points… Identify the problem: Explore feelings: Set goals: from the person’s perspective, ask questions which help the person to obtainclarity, ask questions that will help people to identify a solution.Explore feelings:Feelings are not problems to be solved . Ask people to describe their thoughts.Set goals:help people to decide on their objectives, find out people’s level of commitmentMake a plan:help people to identify one action towards their goal. A plan should be: Realistic,Completely within their control, Measurable and Personally meaningfulExercise: “Bring your sugar level in control”Evaluate the results:encourage people with diabetes to think of these steps in terms of experimentsrather than successes or failures
41 In summary… HEALTH - BELIEF MODEL EMPOWERMENT MODEL Basic Principle: In this model, people’s beliefs are the key factors; people calculate ‘return on investment’ based on own perceptionsAccording to this model, we need to acknowledge that our job is not to make people change, but to provide information, inspiration and support that will enable them to make the changes of their own choosing.Suggested for:Initiating desired behavior changeMaintaining behavior changeIntervention through:Assessment and Addressal of:Perceived severityPerceived susceptibilityValue of the treatmentBarriers to treatmentCost of treatment – physical and emotionalSelf-directed goal setting:Identify the problemExplore feelingsSet goalsMake a planEvaluate the results
42 Customize to patient: Coping level and Patient type What patients would like to know: If I can Understand Diabetes I am Better Prepared to Control itConditionWHY?Limited understanding of the condition, what it entails, why it happened, and that it is manageableAddressing this knowledge gap can help patients feel more confident in managing the condition and less depressed about the state of their health“All knowledge and information that I have gathered so far, I would like to include so that everyone can know and learn how to maintain their diet and maintain their daily routines and meet their normal life.”What?Cure- what the next big thing?Cause – is it hereditary?Symptoms of deteriorationComplications – feet, liver, kidneysPrevention“Everybody says that it is hereditary so I used to feel so bad about it. My daughter is very healthy now, I don’t worry for myself now the concern is more towards her, I don’t want her to be suffer from this disease.”When?At first diagnosisHow?Seminars/lecturesFace to faceConsultative elementNeeds to be supported/managed by medical professionals“Seminars should be arranged because people will attend the seminars.”“There should be patient and doctor interaction and what questions we ask they should tell, like the food and diet and insulin and what are the problems that we may face after some time, if there are new medicine they should tell.”Customize to patient: Coping level and Patient type42
43 Customize to patient: Coping level and Patient type What patients would like to know: Understanding my Medication will help me be more CompliantMedicationWHY?Limited understanding of the medication used and how to administer itAddressing this knowledge gap can help better manage their medication and improve quality of life“I will ask the way to destroy diabetes and what are the bad effects we face from diabetes and new medicines. I want to ask about the eyes and kidneys.”What?Pharmacology of medicineGuidance on how to take medication – dosing, what to do when missed, how to injectSide effectsLength of treatmentOther types of medication available – better ones, oral options (insulin), differences“Different people have different medication and body type is also different.”“How long I have to take insulin?”When?At first diagnosisOn going – for new and existing diabetic patients24/7, easy access (especially for emergencies)“Only when people who are suffering from diabetes.”“Emergency and during weekends.”How?Seminars/lecturesTelephone/Call centresNeeds to be supported/managed by medical professionals“We need call centers and doctors to be there so that we can get immediate response.”Customize to patient: Coping level and Patient type43
44 Customize to patient: Coping level and Patient type What patients would like to know: Understanding Treatment Innovations helps me stay positiveInnovationsWHY?Want to keep abreast of developments, search for alternative treatmentsDesire to stop medication, especially insulinDevelopments in medical sciences and alternative therapies give a sense of hope“Tell us about new medicines and new developments.”“Any new medicine to fully cure diabetes?”What?New treatments availableOther treatments – e.g. stem cell transplant, surgeryLatest research trials“I would ask about pancreas secreting insulin again and if there is there any new technology to transplant the pancreas”“Medicine and new ones – people should tell me about it.”When?On going – for new and existing diabetic patientsConvenient, at patient’s leisureHow?TelephonesFace to face“Telephones are very necessary. “Customize to patient: Coping level and Patient type44
45 Customize to patient: Coping level and Patient type What patients would like to know: How can I Improve my Day-to-Day Management?Day to Day ManagementWHY?Need to have a better understanding of what they can do, what they can eat, why blood glucose level fluctuates, and how to deal with complicationsImproving knowledge on these areas will help patients have better control over their condition“It will have information on food (diet to be eaten), exercise, and managing stress.”“My father use to say without eating food we will die and after eating food also we will die, then I prefer a death with food.”What?Food/DietExerciseBlood glucose control and monitoringHow to deal with hypoglycaemiaHow to treat/prevent infections/wounds“Recently I know that you should avoid the potassium rich food because over a period of time it might affect your kidney.”“Why my sugar level not going down?”“How to avoid hypo?”When?At first diagnosisOn going – for new and existing patientsHow?Seminars/lecturesTelephoneNeeds to be personalised, each patient is different“There should be call centers and they should be able to tell what kind of food we should take and how to control everything.”Customize to patient: Coping level and Patient type45
46 What patients would like to know: Where do I turn to for emergency & peripheral support? WHY?Need access to advice in times of emergencyAssistance with getting medical attentionAssistance in times of need will help patients in the management of their disease“We need call centers and doctors to be there so that we can get immediate response”if there is a call center and a specialist doctor ready to attend us then it would be really good. In emergencies we can call, we can avoid so many problems. We can ask many questions when there is an emergency, if I eat more sweets that day, if there is new service its will be good.”What?Questions on medicine – what to do when missed a doseWhat to do when there experiencing hypoglycaemiaTransportation (to hospitalsWhen?On going – for new and existing diabetic patientsHow?Telephone/Call centres (for emergencies)Home care service“Telephones are very necessary…for emergency and in general holidays.”Customize to patient: Coping level and Patient type46
47 Customize to patient: Coping level and Patient type What patients would like to know: Where do I turn to for financial support?Financial SupportWHY?Diabetes is a long term disease and medication is expensiveHelping lower income patients with their financial difficulties will help to reduce some of the anxiety they experience with having this condition“At the age of 35 I am suffering for sugar, which is very costly and painful. Will it cure permanently?”“It’s a serious disease and incurred huge cost.”What?Cost of medicationsCost of tests“It would be good if they can get free medicine, free treatment.”When?At first diagnosisOn-going – for lower income patients/those with financial difficultiesHow?Free medicationBetter insurance coverage – to include blood glucose tests“The patient support programme should help patients get free medicine, free treatment.”Customize to patient: Coping level and Patient type47
48 What patients would like to know: Emotional Needs – Mental Well-Being WHY?Need to relieve stress and improve psychological well-beingIncreased information on condition, medication and management from onset will better equip and reassure patients that this is manageable, and reduce the stress and anxiety associated with diabetes“Its very stressful because of my age.”“If we can control diabetes then we can live happily.”What?Stress/mood managementReduce fear associated with having diabetesDevelop and maintain positive thinkingLearn from others, and not feel alone“Why do I feel so anxious? How can I best manage the way I feel? It would be good if there are other patients to discuss with also?”When?At first diagnosisOn going – for new and existing diabetic patientsHow?Social groupsTelephonePublic education on diabetes“A phone facility to call and discuss with any doctor and other patient.”“It is a social stigma also.”Customize to patient: Coping level and Patient type48
49 Counseling care-givers… How much do caregivers know? Many caregivers feel they do not know enough about diabetes managementElements of conditionCauses of diabetesTreating condition with medicationCoping strategies to minimize the impactAvoid complicationsAble to find informationSupport a patient in self-managementFour in five caregivers feel they don’t know enoughThree in five feel they don’t know enoughFour in five caregivers feel they know enoughThree in five caregivers feel they don’t know enoughThree in five caregivers feel they know enoughReasonsCaregivers are concerned about how to help patients, not why they got the diseasePhysician is the only source, and sometimes difficult to understandPhysicians explained clearly.Caregivers feel they know enough just to follow instructionsPhysician’s information is not well enoughDiscuss with doctors not really sure where to findHave been a caregiver for years.Quotes“I am not interested why he got his diabetes, but how can I help him to control the disease”“I just receive some advice from the doctors, but I don’t really understand.”“Physician explained to me what and how should I do clearly, I feel I can just follow his instructions.”“Physician just told us to avoid complications, but didn’t tell me how to do.”“If I have any questions, I would just go asking the doctors, I don’t really know other sources”“I took care of him for 8 years, I feel much more experienced now, I believe I could do a good job.”49
50 Counseling care-givers… Basic Health Education- to equip them with informationrelated to managing the patient with regard to treatmentIndividual case-work for ‘care-giver stress’- Caring for theirloved ones can make caregivers forget themselves. They feelguilty if they leave the patient unattended, they stop going outdue to social pressure, and this leads to burnout or ‘care-giverstress’. This also brings in feelings of guilt in the patient.Therefore, counseling on the importance of self-care is a must.Family therapy- involves opening up communication channelsbetween patients and their families.
51 Patient Satisfact- ion Where do I want to be?Patient Satisfact- ionPatient ServicePatient Delight
52 Patient Delight Moments of Truth* First Interaction Subsequent Entry intoSystemSubsequentInteractionsProactiveor ReactiveMomentsOf TruthPatientDelight
53 Patient Empathy- The Differentiator You do not merely wantto be considered the best of the best…. You want to be consideredthe only one who does what you do !!!
54 Thank You How did you find this session ? One thing you will try to do differently going forward